Antibiotic prescribing in dental medicine-best practices for successful implementation

• Published in: Tropical medicine and infectious disease Vol. 9; no. 2; pp. 1 - 20
• Main Authors: Oana Sandulescu, Liliana Lucia Preotescu, Adrian Streinu-Cercel, Gulsen Ozkaya Sahin, Mihai Sandulescu
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland MDPI 2024; MDPI AG
• Subjects: Analysis; Anti-infective agents; antibiotic resistance; Antibiotics; Antimicrobial agents; antimicrobial use; Bacteria; Basic Medicine; Best practices; Dental therapeutics; Dentistry; Drug resistance; Drug resistance in microorganisms; Imipenem; Industrialized nations; Lavage; Low income groups; Medical and Health Sciences; Medicin och hälsovetenskap; Medicine; Medicinska och farmaceutiska grundvetenskaper; Methicillin; One health; Pandemics; Pathogens; Pharmaceutical policy; Practice; Prescription drugs; rational use; Review; Samhällsfarmaci och klinisk farmaci; Social and Clinical Pharmacy; Staphylococcus infections; Streptococcus infections; Tetracycline; Tetracyclines; United Kingdom; Sweden; Romania; Australia; Croatia; Africa; rational use; antimicrobial use; antibiotic resistance; dentistry; antibiotics
• ISSN: 2414-6366; 2414-6366
• DOI: 10.3390/tropicalmed9020031

With rising rates of antimicrobial resistance throughout the world, it is time to revisit antibiotic prescribing policies and practices, and dentistry is an important area for focused inter- vention, as it accounts for up to 15% of all antimicrobial prescriptions. In this narrative review, we have analyzed the current state of the knowledge, attitudes, and practice regarding antimicrobial use among dental professionals, and we have identified a set of seven recurring themes that drive inappropriate antibiotic prescribing in dental medicine. These include: 1. Prescribing antibiotics to delay or avoid dental treatment. 2. Overlooking the 5Ds-dental treatment (source control), dental condition (indication), drug (antibiotic choice), dose, and duration. 3. Relying on education from the distant past and on previous experience. 4. The heterogeneity of (too many) guideline recom- mendations leads to confusion and over-prescribing. 5. Decreased access to guideline information in private practice. 6. Psychological factors such as pressure to prescribe, comfort prescribing and the weekend effect, and 7. Feeling removed from antimicrobial resistance and externalizing responsibility. Based on the existing knowledge, we propose a framework based on four key pillars for focused in- tervention: 1. Education. 2. Internalizing responsibility. 3. Recognizing recurring counter-productive practices, and 4. Addressing recurring counter-productive practices. This framework can be applied in different dental settings to ensure best practices for the successful implementation of rational antimicrobial prescribing.